American Medical Association Family Medical Guide - American Medical Association [416]
Damage to the brain’s language centers
Broca’s area and Wernicke’s area are the brain’s language centers. Broca’s area controls speech; Wernicke’s area controls language comprehension. Damage to these areas can impair a person’s ability to speak or to understand spoken language.
Therapy usually begins slowly, with less difficult activities such as changing positions in bed and performing range-of-motion exercises (see page 190); these activities help keep the blood flowing, maintain muscle tone and joint flexibility, and prevent pressure sores (see page 184). Gradually, you can be helped to sit up in bed and move from the bed. You will stand and walk with assistance until you are strong enough to stand and walk on your own. Eventually you will be encouraged to do more complex tasks such as bathing, dressing, and using the toilet.
Rehabilitation is more likely to be successful if the caregivers know what to expect and what to do. If you are caring for someone who is recovering from a stroke, ask the doctor or nurse what the person can do alone, what he or she needs help doing, and what he or she cannot do. If you do not understand something, ask questions. As much as possible, encourage the person to practice doing things for himself or herself.
Classes for stroke survivors and their families and friends are available in many communities. Support groups are also good sources of information and guidance. Ask your doctor to recommend classes or a support group in your area.
Carotid Endarterectomy
Carotid endarterectomy is a surgical procedure to remove fatty deposits (called plaque) caused by atherosclerosis (see page 557) from affected sections of the walls of one of the carotid arteries (the main arteries in the neck) to restore blood flow to the brain and prevent blood clots from forming and causing a stroke.
Doctors usually recommend carotid endarterectomy for people who have had warning signs of a stroke called transient ischemic attacks (TIAs; see next page) or a mild stroke, especially if an imaging examination called a cerebral angiogram shows significant narrowing (at least 70 percent) of the affected carotid artery. Carotid endarterectomy is not recommended when an artery is completely blocked.
The procedure usually takes less than an hour. During surgery, you are under general anesthesia. The surgeon makes a vertical incision in the side of your neck to reveal the carotid artery and clamps the artery at both sides of the obstruction to temporarily stop blood flow through the artery. He or she then makes a vertical incision in the artery wall at the obstructed area, exposing the plaque. The surgeon scrapes the fatty material away from the artery wall, removes it from the artery, and stitches closed the incisions in the artery and in the neck. In some cases, a damaged section of the artery is replaced with a graft.
Separating plaque from the artery wall
After surgery, you will need to remain in the hospital while your condition is monitored. Before you leave the hospital, your doctor will probably talk to you about making positive lifestyle changes—such as exercising regularly, maintaining a healthy weight, and controlling your cholesterol—to help you avoid another stroke. He or she may also prescribe medication to improve your cholesterol profile (see page 146) and anticoagulant medication to help prevent new blood clots from forming.
Removing plaque from the artery
A rehabilitation team of health care professionals and others works closely with a stroke survivor and his or her caregivers. A rehabilitation team may include the following:
• Doctors Doctors—such as a neurologist (a doctor who specializes in treating disorders of the nervous system), a physiatrist (a doctor who specializes in physical medicine and rehabilitation),